Amebic meningoencephalitides and keratitis: challenges in diagnosis and treatment*

Visvesvara, Govinda S.

doi:10.1097/qco.0b013e32833ed78b

Cited by 108 publications

(97 citation statements)

References 36 publications

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“…To our knowledge, there are only a few reported cases of patients, including immunocompromised patients and those with HIV infection, surviving GAE due to Acanthamoeba and Balamuthia mandrillaris (1,3,4,5,6,7,10,14,15,16,25). Although there is no accepted treatment regimen for Acanthamoeba spp.…”

Section: Case Reportmentioning

confidence: 99%

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Balamuthia mandrillaris and Acanthamoeba Amebic Encephalitis with Neurotoxoplasmosis Coinfection in a Patient with Advanced HIV Infection

et al. 2012

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We describe a patient with advanced HIV infection and Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with Toxoplasma gondii coinfection. A multidisciplinary effort and state-of-the-art diagnostic techniques were required for diagnosis. Our patient is the first reported case of an HIV-infected person with dual Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection. CASE REPORT

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Section: Case Reportmentioning

confidence: 99%

“…Acanthamoeba spp., Naegleria fowleri, and Balamuthia mandrillaris are pathogenic free-living amebae that cause human disease (17,25). Balamuthia mandrillaris was first classified as a leptomyxid ameba when isolated from the brain of an infected pregnant mandrill in 1986 (26).…”

Section: Case Reportmentioning

confidence: 99%

Balamuthia mandrillaris and Acanthamoeba Amebic Encephalitis with Neurotoxoplasmosis Coinfection in a Patient with Advanced HIV Infection

et al. 2012

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“…Amphotericin B may also cause anemia, and many patients experience chills, fever, nausea, vomiting, and headache (23,25). Moreover, only 10 persons with PAM have been treated successfully with amphotericin B, alone or in combination with other drugs (1,2,6,17,20,21,24,(28)(29)(30)(31)(33)(34)(35). Therefore, fast-acting and efficient drugs are urgently needed for the treatment of PAM.…”

mentioning

confidence: 99%

“…Amphotericin B remains a cornerstone of therapy for PAM, but this requires a high dosage, and its use is frequently associated with renal toxicity, manifested as azotemia and hypokalemia (34). Amphotericin B may also cause anemia, and many patients experience chills, fever, nausea, vomiting, and headache (23,25).…”

mentioning

confidence: 99%

Corifungin, a New Drug Lead against Naegleria, Identified from a High-Throughput Screen

Debnath

Tunac²,

Galindo-Gómez

et al. 2012

Antimicrob Agents Chemother

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c Primary amebic meningoencephalitis (PAM) is a rapidly fatal infection caused by the free-living ameba Naegleria fowleri. The drug of choice in treating PAM is the antifungal antibiotic amphotericin B, but its use is associated with severe adverse effects. Moreover, few patients treated with amphotericin B have survived PAM. Therefore, fast-acting and efficient drugs are urgently needed for the treatment of PAM. To facilitate drug screening for this pathogen, an automated, high-throughput screening methodology was developed and validated for the closely related species Naegleria gruberi. Five kinase inhibitors and an NFkappaB inhibitor were hits identified in primary screens of three compound libraries. Most importantly for a preclinical drug discovery pipeline, we identified corifungin, a water-soluble polyene macrolide with a higher activity against Naegleria than that of amphotericin B. Transmission electron microscopy of N. fowleri trophozoites incubated with different concentrations of corifungin showed disruption of cytoplasmic and plasma membranes and alterations in mitochondria, followed by complete lysis of amebae. In vivo efficacy of corifungin in a mouse model of PAM was confirmed by an absence of detectable amebae in the brain and 100% survival of mice for 17 days postinfection for a single daily intraperitoneal dose of 9 mg/kg of body weight given for 10 days. The same dose of amphotericin B did not reduce ameba growth, and mouse survival was compromised. Based on these results, the U.S. FDA has approved orphan drug status for corifungin for the treatment of PAM.

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“…Balamuthia has been identified in infections in both immunocompromised and immunocompetent patients. There is no clear predilection based on age or sex, but cases have been reported from individuals at the extremes of age, and the earliest reported cases were in patients with AIDS or substance abuse disorders (2,11). While there is an overrepresentation of Hispanic ethnicity among reported cases, the cause of this association is not understood and may be related to surveillance, exposure, biology, or other factors or combinations of factors (9,12).…”

Section: Microbiologymentioning

confidence: 96%

Disseminated Balamuthia mandrillaris Infection

et al. 2015

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f Balamuthia mandrillaris is a rare cause of human infection, but when infections do occur, they result in high rates of morbidity and mortality. A case of disseminated Balamuthia infection is presented. Early diagnosis and initiation of recommended therapy are essential for increased chances of successful outcomes. CASE REPORTT he patient was an 82-year-old white male with a history of necrobiosis lipoidica versus granuloma annulare of the right hand who was admitted in April 2012 for acute onset of fevers, chills, nausea, vomiting, lethargy, and altered mental status (AMS). He initially presented to an outside-hospital emergency department with a temperature of 38.5°C, a heart rate of 97 beats per min, and oxygen saturation of 88% on room air. His oxygen saturation improved with administration of nasal cannula oxygen. A chest X-ray (CXR) procedure was performed and demonstrated findings concerning for granulomatous disease. Due to his condition, he was transferred to our tertiary care center for further evaluation and treatment.Per his family, he had been healthy and without complaints prior to his current presentation. For approximately 15 months, he had been treated by a dermatologist for skin lesions located on his right thigh and hand as well as left upper extremity (LUE) and abdomen. He had multiple skin biopsy specimens from the right hand, LUE, and right thigh with negative bacterial, acid-fast bacillus (AFB), and fungal analysis results. During this period of time, he took itraconazole for 3 months without clinical response and was thus started on prednisone. All lesions resolved except those on his right hand. He was treated with a 14-day course of doxycycline and cephalexin for possible cellulitis of the right hand prior to this admission. Previous workup included a negative syphilis screen and a normal angiotensin-converting enzyme (ACE) level (drawn for possible sarcoidosis). A CXR performed at that time revealed nonspecific interstitial changes.A review of the patient's symptoms was obtained from family members given the patient's AMS. Per their report, the patient reported a headache but no neck pain or stiffness. He had no history of mouth sores or genital ulcers and had a remote history of shingles. He had had an episode of bronchitis 1 month prior to admission (PTA) that was slow to improve but gradually resolved.In terms of exposures, he had no history of international travel but did have seawater exposure on the Gulf Coast of Alabama 1 month prior to admission. He had no pets but had been mowing grass and spreading grass seed PTA. He had no known tick bites but spent time outdoors using a metal detector for treasure hunting and digging in soil. Previously, he had taught a bible study group in a prison but had no known tuberculosis (TB) exposure and no previous TB testing.In an initial physical examination, he was febrile to 38.2°C and his oxygen saturation was 94% with 2 liters of oxygen administered using a nasal cannula. He was initially agitated and confused but progressed to somnolence o...

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Amebic meningoencephalitides and keratitis: challenges in diagnosis and treatment*

Cited by 108 publications

References 36 publications

Balamuthia mandrillaris and Acanthamoeba Amebic Encephalitis with Neurotoxoplasmosis Coinfection in a Patient with Advanced HIV Infection

Balamuthia mandrillaris and Acanthamoeba Amebic Encephalitis with Neurotoxoplasmosis Coinfection in a Patient with Advanced HIV Infection

Corifungin, a New Drug Lead against Naegleria, Identified from a High-Throughput Screen

Disseminated Balamuthia mandrillaris Infection

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